Features of Psychopharmacotherapy in Patients with a Transdiagnostic Phenomenon of Non-Suicidal Self-Injurious Behavior

Background: non-suicidal self-injury (NSSI) is a prevalent transdiagnostic phenomenon that modifies the course of the primary disorder and can be considered as a potential transdiagnostic clinical marker for psychopharmacotherapy (PT) personalization. To date, there are no evidence-based recommendations for the PT of patients with specific mental disorders with comorbid NSSI. Analysis of real-world data (RWD) allow evaluation of empirically developed pharmacotherapeutic approaches formed through routine clinical practice in patients with NSSI. However, to our knowledge, such studies have not yet been conducted. Aim: to assess the associations between presence of NSSI as a transdiagnostic phenomenon and the characteristics of PT in patients with affective disorders and schizophrenia spectrum disorders, using RWD. Materials and Methods: medical records containing lifetime PT data were analyzed for 126 patients (54.8% (n = 69) women; median (Q1; Q3) age: 22 (20; 24) years; 52.4% (n = 66) with schizophrenia spectrum disorders (ICD-10 diagnoses F20, F21, F25 — group 2) or with affective disorders (ICD-10 diagnoses F31, F32, F33 — group 3). NSSI was present in 69,8% (n = 88) of patients. Statistical analysis included between-group comparisons, along with regression analyses for combined assessment of the effects of diagnostic group and NSSI factors. Results: patients with NSSI received significantly more intensive mood stabilizer therapy (mean lithium equivalents, mg/day: 280,1 (78.8; 592.0) vs. 5.3 (0; 468.0), p = 0.002) and more frequently received regular tranquilizer therapy (percentage of total treatment length: 0 (0; 8,47) vs. 0 (0; 0), p = 0.007). Regression analyses confirmed a significant association between the presence of NSSI and more intensive mood stabilizer therapy (p = 0.011), as well as longer duration of tranquilizer treatment (p = 0.026). The latter association was more pronounced in patients with affective disorders. Conclusions: this pilot RWD study identified several transdiagnostic features of PT in patients with comorbid NSSI, which allow to consider NSSI as a transdiagnostic clinical marker for PT personalization. These findings may serve as a basis for evaluating the efficacy and safety of the identified therapeutic strategies in randomized clinical trials.

1. Klonsky ED, Victor SE, Saffer BY. Nonsuicidal self-injury: what we know, and what we need to know. Can J Psychiatry. 2014;59(11):565–568. doi: 10.1177/070674371405901101

2. Cheng H, Wang D, Wang L, Zou H, Qu Y. Global prevalence of self-harm during the COVID-19 pandemic: a systematic review and meta-analysis. BMC Psychol. 2023;11(1):149. Published 2023 May 5. doi: 10.1186/s40359-023-01181-8

3. Swannell SV, Martin GE, Page A, Hasking P, St John NJ. Prevalence of nonsuicidal self-injury in nonclinical samples: systematic review, meta-analysis and meta-regression. Suicide Life Threat Behav. 2014;44(3):273–303. doi: 10.1111/sltb.12070

4. Kibitov AA, Potanin SS, Borodin VI, Morozova MA. Non-suicidal self-injurious behavior in students of Russian universities: the results of an online survey of 3,925 subjects. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;125(10):128–136. (In Russ.). doi: 10.17116/jnevro2025125101128

5. Franklin JC, Ribeiro JD, Fox KR, Bentley KH, Kleiman EM, Huang X, Musacchio KM, Jaroszewski AC, Chang BP, Nock MK. Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychol Bull. 2017 Feb;143(2):187–232. doi: 10.1037/bul0000084. Epub 2016 Nov 14.

6. Ose SO, Tveit T, Mehlum L. Non-suicidal self-injury (NSSI) in adult psychiatric outpatients — A nationwide study. J Psychiatr Res. 2021;133:1–9. doi: 10.1016/j.jpsychires.2020.11.031

7. Pan B, Gong Y, Guo M, Wang X, Lu H, Lin Z, Zhang B.Negative Affect and Impulsivity in Adolescents with Non-Suicidal Self-Injury: The Moderating and Mediating Roles of Perceived Social Support. Neuropsychiatr Dis Treat. 2025;21:1–13. doi: 10.2147/NDT.S498951

8. Antezana L, Garcia KM, Carlton CN, Villalongo Andino M, Gatto AJ, Richey JA. Transdiagnostic Correlates of Nonsuicidal Self-Injury: The Roles of Anhedonia, Repetitive Negative Thinking, and Trait Mindfulness. J Psychopathol Behav Assess. 2024;46(2):566–579. doi: 10.1007/s10862-024-10130-7. Epub 2024 Mar 20. PMID: 40756307

9. Eggart V, Cordier S, Hasan A, Wagner E. Psychotropic drugs for the treatment of non-suicidal self-injury in children and adolescents: a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci. 2022;272(8):1559–1568. doi: 10.1007/s00406-022-01385-w

10. Chen X, Dong Y, Ye M, Wang X, Yan J, Yao Y, Qi Z, Qian C, Liu Z.Comparative efficacy and acceptability of psychotherapeutic, pharmacological, and combination treatments for non-suicidal self-injury in children and adolescents: a systematic review and network meta-analysis. BMC Psychiatry. 2025;25(1):328. Published 2025 Apr 3. doi: 10.1186/s12888-025-06735-1

11. Dang A. Real-World Evidence: A Primer. Pharmaceut Med. 2023;37(1):25–36. doi: 10.1007/s40290-022-00456-6

12. Yao Z, McCall WV. Designing Clinical Trials to Assess the Impact of Pharmacological Treatment for Suicidal Ideation/Behavior: Issues and Potential Solutions. Pharmaceut Med. 2023;37(3):221–232. doi: 10.1007/s40290-023-00467-x

13. Hayasaka Y, Purgato M, Magni LR, Ogawa Y, Takeshima N, Cipriani A, Barbui C, Leucht S, Furukawa TA. Dose equivalents of antidepressants: Evidence-based recommendations from randomized controlled trials. J Affect Disord. 2015;180:179–184. doi: 10.1016/j.jad.2015.03.021

14. Gardner DM, Murphy AL, O'Donnell H, Centorrino F, Baldessarini RJ. International consensus study of antipsychotic dosing. Am J Psychiatry. 2010;167(6):686– 693. doi: 10.1176/appi.ajp.2009.09060802

15. McAdam MK, Baldessar ini RJ, Murphy AL, Gardner DM. Second International Consensus Study of Antipsychotic Dosing (ICSAD-2). J Psychopharmacol. 2023;37(10):982–991. doi: 10.1177/02698811231205688

16. Wang Y, Chew QH, Lin SK, Yang SY, Ouyang WC, Chen CK, Park SC, Jang OJ, Park JH, Chee KY, Ding KS, Chong J, Zhang L, Li K, Zhu X, Jatchavala C, Pariwatcharakul P, Kallivayalil RA, Grover S, Avasthi A, Ansari M, Maramis MM, Aung PP, Sartorius N, Xiang YT, Tan CH, Chong MY, Park YC, Kato TA, Shinfuku N, Baldessarini RJ, Sim K. Dosing of Mood Stabilizers for Bipolar Disorder Patients in the Research on Asian Psychotropic Prescription Patterns Consortium Study. J Clin Psychopharmacol. 2022;42(3):293–297. doi: 10.1097/JCP.0000000000001549

17. Shaposhnikova YV. Features of drug treatment of patients with non-psychotic mental disorders and non-suicidal self-harm in adolescence. Mental Health. 2024;19(2):56–60. (In Russ.). doi: 10.25557/2074-014X.2024.02.56-60

18. Placini F, Bargnesi F, Di Cicco D, Rinaldi D, Balestra S, Berloffa S, Viglione V, Fantozzi P, Tolomei G, Schirone G, Milone A, Masi G, Sesso G.Extended-Release Lithium Sulfate in Adolescents with Bipolar Disorder: Results from a Longitudinal Prospective Cohort Study. J Child Adolesc Psychopharmacol. 2025;35(1):37–48. doi: 10.1089/cap.2024.0092

19. Jin W, Chen Z, Chen H, Di L, Sun F. Systematic Review and Meta-Analysis of Mood Stabilizers in the Treatment of Adolescent Patients With Nonsuicidal Self-Injury in China. J Clin Psychiatry. 2026;87(3):25r16158. doi: 10.4088/JCP.25r16158

20. Wolff JC, Thompson E, Thomas SA, Nesi J, Bettis AH, Ransford B, Scopelliti K, Frazier EA, Liu RT. Emotion dysregulation and non-suicidal self-injury: A systematic review and meta-analysis. Eur Psychiatry. 2019;59:25–36. doi: 10.1016/j.eurpsy.2019.03.004

21. Shi J, Gao P, Zhou B, Huang Z. A meta-analysis of the relationship between anxiety and non-suicidal self-injury based on knowledge graphs. Front Psychiatry. 2025;15:1493823. Published 2025 Jan 6. doi: 10.3389/fpsyt.2024.1493823

22. Dodds TJ. Prescribed Benzodiazepines and Suicide Risk: A Review of the Literature. Prim Care Companion CNS Disord. 2017;19(2):10.4088/PCC.16r02037. Published 2017 Mar 2. doi: 10.4088/PCC.16r02037

23. Liu RT. The epidemiology of non-suicidal self-injury: lifetime prevalence, sociodemographic and clinical correlates, and treatment use in a nationally representative sample of adults in England. Psychol Med. 2023;53(1):274–282. doi: 10.1017/S003329172100146X

24. Klonsky ED. Non-suicidal self-injury in United States adults: prevalence, sociodemographics, topography and functions. Psychol Med. 2011;41(9):1981–1986. doi: 10.1017/S0033291710002497